Evidence map›Paper›PMID 26375953›Full record

SynthesisPloS one2015

The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis.

Susannah Fleming, Peter Gill, Caroline Jones, James A Taylor, Ann Van den Bruel, Carl Heneghan, Nia Roberts, Matthew Thompson

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 4 pooled it
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 4 syntheses or guidelines pooled it, 105 citations in OpenAlex.

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  11. DiCARTJournal of clinical monitoring and computing · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 3 countries.

Susannah FlemingNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
Peter GillThe Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Caroline JonesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
James A TaylorChild Health Institute, University of Washington, Seattle, Washington, United States of America.
Ann Van den BruelNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
Carl HeneghanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
Nia RobertsBodleian Health Care Libraries, University of Oxford, Oxford, Oxfordshire, United Kingdom.
Matthew ThompsonDepartment of Family Medicine, University of Washington, Seattle, Washington, United States of America.
University of Oxford · GBUniversity of Washington · USUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

importanceCapillary refill time (CRT) is widely recommended as part of the routine assessment of unwell children.

objectiveTo determine the diagnostic value of capillary refill time for a range of serious outcomes in children.

methodsWe searched Medline, Embase and CINAHL from inception to June 2014. We included studies that measured both capillary refill time and a relevant clinical outcome such as mortality, dehydration, meningitis, or other serious illnesses in children aged up to 18 years of age. We screened 1,265 references, of which 24 papers were included in this review. Where sufficient studies were available, we conducted meta-analysis and constructed hierarchical summary ROC curves.

resultsMeta-analysis on the relationship between capillary refill time and mortality resulted in sensitivity of 34.6% (95% CI 23.9 to 47.1%), specificity 92.3% (88.6 to 94.8%), positive likelihood ratio 4.49 (3.06 to 6.57), and negative likelihood ratio 0.71 (0.60 to 0.84). Studies of children attending Emergency Departments with vomiting and diarrhea showed that capillary refill time had specificity of 89 to 94% for identifying 5% dehydration, but sensitivity ranged from 0 to 94%. This level of heterogeneity precluded formal meta-analysis of this outcome. Meta-analysis was not possible for other outcomes due to insufficient data, but we found consistently high specificity for a range of outcomes including meningitis, sepsis, admission to hospital, hypoxia, severity of illness and dengue.

conclusionsOur results show that capillary refill time is a specific sign, indicating that it can be used as a "red-flag": children with prolonged capillary refill time have a four-fold risk of dying compared to children with normal capillary refill time. The low sensitivity means that a normal capillary refill time should not reassure clinicians.

Indexed as

Severity of Illness IndexBlood Flow VelocityCapillariesChildDehydrationDiagnostic Techniques and ProceduresFeverHumansRegional Blood Flow

Identifiers

PMID26375953
PMCPMC4573516
OpenAlexW2266551370

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.